Provider Demographics
NPI:1285646950
Name:GARY B. BRYANT, MD, PC
Entity Type:Organization
Organization Name:GARY B. BRYANT, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-728-4477
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-0240
Mailing Address - Country:US
Mailing Address - Phone:931-728-4477
Mailing Address - Fax:931-728-4997
Practice Address - Street 1:119 E FORT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1508
Practice Address - Country:US
Practice Address - Phone:931-728-4477
Practice Address - Fax:931-728-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD009298261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
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TN3034820OtherBCBS OF TN
TN3158264Medicaid
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TN080145045OtherRAILROAD MEDICARE
TN00001849OtherNHC HEALTH BENEFIT PLAN
TN3158265Medicaid
TN89001688OtherBCBS OF AL
TN3158265Medicaid